End-user Information:
 
 
 
First Name*
 
 
Last Name*
 
 
 
Email Address*
 
 
Job Title
 
 
 
Company Name*
 
 
 
 
Address*
 
 
 
 
City*
 
 
 
 
State/Province*
 
 
Zip / Postal Code*
 
 
 
Country*
 
 
Phone Number*
 
 
 
End-user Dynamics GP Details:
 
 
 
GP Company Site Name*
 
 
MS Account Number*
 
 
 
GP Version*
 
 
# of GP Users*
 
 
 
Length of time on GP or AX*
 
 
If subscription, duration of initial contract
 
 
 
Value-Added Reseller (VAR) Information:
 
 
 
VAR / Partner*
 
 
VAR Contact Name*
 
 
 
VAR Contact Email*
 
 
 
 
Products purchased:
 
 
 
Products Purchased
 
 
 
 
Binary Stream Modules Purchased